Penile Malignancies Research Articles

Evaluation of the Guidelines for Penile Cancer Treatment: Overview and Assessment

Introduction: Medical organizations have provided evidence-based guidelines for penile cancer treatment. This current review aims to compare and appraise guidelines on penile cancer treatment to provide a useful summary for clinicians. make an evidence-based approach in the clinical practice. Materials and Methods: We searched in PubMed and Medline for guidelines published between January 1, 2010, and February 1, 2020. The search query terms were “penile cancer,” “penile tumor,” “guidelines,” and “penile malignancy.” In the final analysis, we include the most recent versions of relevant guidelines published in English. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument was used to appraise the quality of each guideline. Results: In the final analysis, we included guidelines from the National Comprehensive Cancer Network (updated in 2020), The European Association of Urology (updated in 2018), and The European Society for Medical Oncology (published in 2013). The overall agreement among reviewers was excellent. The range of scores for each domain was as follows: scope and purpose (46% to 61%); stakeholder involvement (33% to 60%); rigor of development (34% to 69%); clarity and presentation (61% to 81%); applicability (33% to 59%) and editorial independence (52% to 78%). The European Association of Urology and National Comprehensive Cancer Network clinical practice guidelines received better scores according to the AGREE II evaluation. Conclusion: Despite the effort made by the guidelines groups to make a practical guideline regarding penile cancer treatment, the actual available evidence is weak. However, we believe our recommendations offer clear guidance.

Functional and aesthetic outcome after ventral spatulation of urethra in partial penectomy

Partial penectomy is one of the common organ preserving procedures for penile malignancies and certain benign conditions. Partial penectomy causes psychosexual morbidity to the patient. Dorsal spatulation of urethra is classically done while performing the procedure, it carries risk of meatal stenosis along with compromised cosmesis. Several complex neoglans reconstructive techniques exist to prevent stenosis and improve cosmetic outcomes. We hereby describe outcomes of a simple and reproducible modification of the procedure by ventral spatulation of the urethra. An analysis of 31 partial penectomies from May 2016 to June 2019 using a ventral spatulation technique was done. Patients were followed up for an average of 1 year to look for meatal stenosis, the morphological appearance of residual stump and psychosexual well-being. None of the patient had meatal stenosis on follow up. All patients had a satisfactory cosmetic outcome, scoring 6 or more on ANA scale. Seventeen patients reported "satisfied", six scored "highly satisfied "and eight were "harmonic" with the outcome. Out of 31, significant patients (20) were sexually active with most of them "equally satisfied or dissatisfied" or "very much satisfied." Used uncommonly, ventral spatulation of urethra is a simple, reproducible and less time consuming alternative, which avoids the chances of meatal stenosis and gives goodcosmetic results with psychological benefits to patients.

Penile Rhinoscleroma Masquerading as Penile Malignancy: A Case of Mistaken Identity.

Penile Rhinoscleroma Masquerading as Penile Malignancy: A Case of Mistaken Identity.

The role of penectomy in penile cancer-evolving paradigms.

Penile cancer is a rare cancer, with the majority treated with penile preserving methods. There remains a role for partial and totally penectomy for advanced and more proximal penile cancers. Significant functional and psychological morbidity can ensue for patients undergoing surgical management. Recent studies and guidelines are changing the way Urologists approach surgical management of penile malignancies. Reductions in safe surgical margin recommendations from 2 cm to 3–5 mm provide surgeons with the ability to perform penile preserving techniques to maximise patient functionality. These guidelines are reflected by recent studies showing that smaller surgical margins; although heralding higher rates of local recurrence, have no detriment on cancer specific or overall survival rate. Although oncological clearance remains the primary outcome for surgical management of penile cancer, the ability to perform radical salvage surgery at a later date means patients are more likely to experience a longer period of functionality without sacrificing oncologic outcomes. The importance of patient education on regular self-examination as well as clinic follow up are key in identifying local recurrence and planning salvage surgery if needed to maintain oncologic control. Ongoing studies into the functional and psychological outcomes of patients undergoing partial penectomy show encouraging results however further studies are needed to elucidate long-term outcomes. The evolving paradigm of surgical management in penile malignancy is shifting to favour organ preserving techniques in order to maximise functional, psychological and aesthetic outcomes without compromising patients’ oncologic outcomes—however a role still exists for radical surgery in advanced penile malignancy.

A population-level analysis of nonsquamous penile cancer: The importance of histology

BackgroundNonsquamous penile cancers comprise 5% of penile malignancies, though their clinicopathologic features and prognostic significance remain unknown. We used a national cancer registry to detail clinical characteristics and compare cancer-specific mortality (CSM) of nonsquamous cancers with squamous cell carcinoma (SCC). MethodsThe Surveillance, Epidemiology, and End Results (SEER) database (1975–2016) was queried to identify adults with nonsquamous penile cancer and penile SCC. Multivariable Fine and Gray competing-risks regression, propensity score matching, and cumulative incidence plots were used. Results666 men with nonsquamous penile cancer and 5,894 men with penile SCC were identified. The most commonly represented nonsquamous histological subtypes were Kaposi sarcoma (n = 183, 27.5%), melanoma (n = 74, 11.1%), basal cell carcinoma (n = 65, 9.8%), and extramammary Paget disease (n = 42, 6.3%). Cumulative incidence plots revealed a 10-year CSM rate of 32.6% in the nonsquamous penile cancer group and 25.6% in the matched penile SCC group (P < 0.0001). Among Kaposi sarcoma patients and matched SCC patients, we found a 10-year CSM rate of 29.6% in the Kaposi sarcoma group and 15.3% in the penile SCC group (P = 0.002). Similarly, a comparison of penile melanoma patients with matched SCC patients revealed a 10-year CSM rate of 38.4% in the melanoma group and 16.6% in the SCC group (P = 0.002). There was no difference in CSM between patients with basal cell carcinoma and SCC. In a sensitivity analysis limiting year of diagnosis to 2000 and onward, we found no difference in CSM between the general nonsquamous cohort or the Kaposi sarcoma cohort and matched SCC patients, but contemporary melanoma patients maintained worse CSM with a 10-year rate of 38.4% vs. 15.8% in matched SCC patients (P = 0.045). ConclusionsThe most common nonsquamous penile cancers are Kaposi sarcoma, melanoma, and basal cell carcinoma. Overall, CSM is higher in nonsquamous penile cancers as compared to stage-matched SCC. Outcomes are similar in modern patients, likely due to improved control of systemic HIV in patients with Kaposi sarcoma. However, men with penile melanoma continue to experience a higher rate of CSM.

High grade pleomorphic sarcoma of penis: A rare clinical entity

The incidence of penile cancer has been reported to be around 0.005 % in males, with less than 5% of then being sarcomas among all types of penile malignancies Primary penile sarcoma is a rare disease that affects men of all ages. Different subtypes of primary penile sarcoma exist, with the rarest being pleomorphic sarcoma. Only few cases have been reported on pleomorphic sarcoma of penis with undifferentiated type being most commonly reported. No report on high grade pleomorphic sarcoma has been previously reported in the English literature. We report an extremely rare case of undifferentiated pleomorphic sarcoma of the penis in a 62-year-old patient who initially presented with a recurrent or residual penile lesion. The tumor was surgically excised, but the patient experienced local recurrence and died of metastatic disease 18 months after initial presentation. Keywords: Penile sarcoma penile cancer urogenital sarcoma.

Effective combinatorial immunotherapy for penile squamous cell carcinoma

Penile squamous cell carcinoma (PSCC) accounts for over 95% of penile malignancies and causes significant mortality and morbidity in developing countries. Molecular mechanisms and therapies of PSCC are understudied, owing to scarcity of laboratory models. Herein, we describe a genetically engineered mouse model of PSCC, by co-deletion of Smad4 and Apc in the androgen-responsive epithelium of the penis. Mouse PSCC fosters an immunosuppressive microenvironment with myeloid-derived suppressor cells (MDSCs) as a dominant population. Preclinical trials in the model demonstrate synergistic efficacy of immune checkpoint blockade with the MDSC-diminishing drugs cabozantinib or celecoxib. A critical clinical problem of PSCC is chemoresistance to cisplatin, which is induced by Pten deficiency on the backdrop of Smad4/Apc co-deletion. Drug screen studies informed by targeted proteomics identify a few potential therapeutic strategies for PSCC. Our studies have established what we believe to be essential resources for studying PSCC biology and developing therapeutic strategies.

Abstract C89: Examining HPV awareness, sexual behavior, and intent to receive the HPV vaccine among racial/ethnic males 18-27

Abstract Background: HPV plays a significant role in cancers and diseases that impact males directly including penile, oral, and anal malignancies, but awareness and positive vaccine intention in males remain problematic. HPV research largely focuses on cervical cancer prevention, ultimately feminizing HPV and erroneously portraying HPV as an infection that does not affect men. Incidence rates of oropharyngeal and anal cancers associated with HPV are increasing, and these cancers disproportionately affect men. Additionally, racial/ethnic minority men are disproportionately affected by HPV-related diseases and cancers. Black and Hispanic men are diagnosed with more HPV-related cancers and HPV-related cancers at later stages compared to other racial/ethnic groups. To date, very few studies have focused on HPV among racial/ethnic minority men and sexual. The purpose of this study is to examine 1) the awareness of men about HPV and their sexual behaviors and 2) the association of their intent to receive the HPV vaccination and sexual behaviors among racial/ethnic men. Methods: Racial/ethnic minority men age 18 to 27 (n=190) attending a large public university in the southeast US completed a 20-minute web-based survey in the fall of 2011. Survey items were adapted from previous research of psychosocial HPV studies among men and women, and were based on constructs from the Health Belief Model and Social Cognitive Theory. This analysis examined self-reported data on participants' sociodemographics, sexual behavior, HPV knowledge, vaccine status, and intent to receive HPV vaccination. Univariate analyses examined the sample distribution; Bivariate analyses were conducted to examine racial/ethnic differences sexual behavior and intent to receive the HPV vaccination, and binomial logistic regression analysis examined associations between intent to receive HPV vaccination and sexual behaviors. Results: The mean age of the sample was 21.31 (SD=2.579) years. The men identified themselves as Hispanic or Latino/a (49.5%), African-American /Black (17.9%), Asian (13.7%), Other (12.1%), and White (6.8%). The majority of the sample was insured (79.5%), unmarried/single (83.7%), heterosexual (91.1%), and completed 2 years of college or less (45.3%). Frequency distributions indicated that 73.2% did not consider themselves to be virgins and 49.5% of the sample was currently sexually active. In addition, 79.5% of the sample had previous knowledge about HPV, 81.6% of the sample had not received a dose of the HPV vaccine, and 77.1% did not plan to receive the HPV vaccine. Bivariate analyses showed that Hispanic and Black men were less likely to identify as virgins (p=0.03), more likely to have had vaginal (p=0.01) and oral (p=0.045) sex, and more likely to have vaginal sex at an earlier mean age compared to Asian, White, and Other men. Men who reported having had vaginal sex (28.6%; p=0.01), not being virgins (28.1%; p=0.008), and who were currently sexually active (31.8%; p=0.06) were more likely to have intentions of getting the HPV vaccination. Binomial logistic regression analysis showed that men who thought the HPV vaccine was of moderate importance were more likely than men who thought the HPV vaccine was of low and high importance to intend to receive the HPV vaccine (p=0.02). Conclusion: Although this mostly racial/ethnic minority sample of men were knowledgeable about the HPV vaccine and reported being sexually active, they were still less likely to intend to receive the vaccine. Providing information about HPV at early ages, particularly for Black and Hispanic men, and that it is transmitted through the different sexual behaviors may increase and emphasize the importance of HPV vaccination. Determining factors associated with HPV vaccine intentions among those at risk for HPV is important in increasing uptake of the vaccine and decreasing the burden of HPV-related diseases. Citation Format: Dexter L. Cooper, Natalie D. Hernandez, Tiffany Zellner-Lawrence. Examining HPV awareness, sexual behavior, and intent to receive the HPV vaccine among racial/ethnic males 18-27 [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C89.

Clinical study of nodal involvement in carcinoma penis: role of perineural and perivascular invasion in lymph node metastasis

Background: Penile malignancies constitute a major health problem in the developing countries especially the Afro Asian countries. It constitutes about 10% of all malignancy. The incidence of the penile malignancy is in decreasing trend in many parts of the world due to improved awareness about the personal hygiene. In this study special effort was made to analyze the histopathological correlation in predicting the lymph node involvement particularly the perivascular and perineural invasion of a tumor on his to pathology and its influence on the lymph node metastasis.Methods: After getting prior ethical committee clearance 42 cases of histopathologically proven cases are included in the study. Those patients included are explained about the nature of the study, investigations that are done. They have also discussed the various treatment options available in Thanjavur medical college. Proper consent in patients own language is obtained before including in the study.Results: The most common histological type found in present study was squalors type. More than 90% (93%) shows squamous variety. Verrucous carcinoma was found in two patients. One patient present with the mixed presentation.Conclusions: Tumour with high grade, high stage, and perineural and per vascular invasion is associated with more nodal metastasis. It is highly recommended to carry out nodal dissection in such types of a tumor. Screening for the early stage of the disease and addressing for the inguinal nodes for the high-risk group will significantly reduce the morbidity and mortality of carcinoma penis.

Abstract C90: Examining racial and ethnic disparities in HPV awareness and the association of trust in cancer information from physicians among males

Abstract Background: Human papillomavirus (HPV) is the most common sexually transmitted virus in the United States, however the focus is heavily placed on its effects on women's health. Men with HPV are also affected, in that, they are at an increased risk of developing penile, oral, and anal malignancies. In fact, approximately 9,251 male cancers in 2014 were attributed to HPV. In addition, black and Hispanic men are diagnosed with more HPV-related cancers and HPV-related cancers at later stages compared to other racial/ethnic groups. Physician communication with male patients about HPV vaccination may be beneficial to increasing HPV vaccinations and decreasing HPV transmission. The purpose of this study is to examine 1) the awareness of men about HPV and the HPV vaccine by race and 2) the association of trust in information from physicians about cancer and ever hearing about HPV and the HPV vaccine. Methods: Data for this study is from the National Cancer Institute's 2014 Health Information National Trends Survey (HINTS) DATA 4 Cycle 4, a nationally representative cross-sectional population-based study about cancer-related information. The current study included 1,203 males who reside in the United States. The study analyzed self-reported data on participants' demographics, HPV knowledge, and physician communication about HPV vaccination. Chi-square tests were conducted to examine racial/ethnic differences in knowledge and physician communication about the HPV vaccination. Binomial logistic regression analysis examined associations between hearing of HPV and communication about HPV with a physician while controlling for demographics, health insurance status, family dynamics, trust of cancer information from a physician, and having a regular physician. Results: The mean age of the sample was 56.79 (SD=15.43) years. The sample was 70% non-Hispanic white, 14% non-Hispanic black, and 16% Hispanic men. The majority of the sample was insured (91%), married (61%), employed (51%), and had a college or post graduate education (43%). Frequency distributions indicated that 50% of the sample had never heard of HPV and 53% had never heard of the HPV vaccine. Chi square tests showed that black men (52.1%) were more likely to not know that HPV is sexually transmitted compared to white (32.5%) and Hispanic (19.8%) men (p&amp;lt;.001). Hispanic (62.6%) and black (63.5%) men were less likely to have heard about a vaccine to prevent HPV infection when compared to White (48.3%) men (p&amp;lt;.001). In addition Hispanic men (58.6%) were less likely to trust a doctor about cancer information compared to white (71.0%) and black (74.3%) men. Binomial logistic regression analysis showed that men had greater odds of hearing about HPV if they were younger, had some college/post high school training or more education, and lived in a household with an income of $100,000 or more annually. Models indicated that having a regular provider was no longer significant when trust of cancer information from the doctor was added to the model. Binomial logistic regression analysis showed that men had greater odds of hearing about the HPV vaccine if they were non-Hispanic white, younger, insured, had a regular provider, employed or retired, had some college/post high school training or more education, and lived in a household with an income higher than $34,999 annually. Conclusion: In general, men are not receiving the information about the HPV or how it is transmitted. Furthermore, racial/ethnic differences were found in being informed about the HPV vaccine and trust in receiving cancer information from physicians. Findings suggest that men's lack of knowledge about HPV and the lack of trust of cancer information from physicians may be linked to a lack of HPV vaccinations. Future health communications efforts should explore community-based and culturally sensitive methods to disseminate HPV information to men. Note: This abstract was not presented at the conference. Citation Format: Dexter L. Cooper, Natalie D. Hernandez, Latrice Rollins, Tabia Henry-Akintobi, Calvin McCallister. Examining racial and ethnic disparities in HPV awareness and the association of trust in cancer information from physicians among males. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C90.

Outcomes in urological cancer are strongly influenced by route to diagnosis

Introduction: The Routes to Diagnosis study has recorded data on new cancer diagnoses since 2006. The route to diagnosis of urological cancer influences outcomes and factors including gender, age and deprivation are implicated in affecting the way in which patients present. Materials and methods: Data were obtained from the National Cancer Intelligence Network Routes to Diagnosis study. Every new cancer case is assigned to one of eight routes of diagnosis, seven of which are applicable to urological cancers. Data from 2006 to 2013 are described in this report. Results: Two week wait is the most common route to diagnosis of bladder and testicular cancer compared to prostate, renal and penile malignancy in which routine general practitioner referral was the most common route. Two week wait referrals are associated with the best survival, and emergency presentations with the worst. Emergency presentation increases with advancing age but is also noted to be a significant route to diagnosis in patients less than 50 years. Bladder and renal cancer are more common in men but the route to diagnosis varies with gender. Increasing deprivation increases emergency presentation but has minimal effect on two week wait and routine general practitioner referrals. Conclusion: National data on the impact of route to diagnosis of urological malignancy have been described for the first time. The effect of age and gender on route to diagnosis and consequently cancer outcome has been noted. To enable earlier diagnosis attention must focus on extremes of age, patients with penile cancer and the most deprived patients.

Erythroplasia of Queyrat treated by laser and light modalities: a systematic review.

Erythroplasia of Queyrat (EOQ) is a squamous cell carcinoma in situ most commonly located on the glans penis or prepuce. EOQ accounts for roughly 10% of all penile malignancies and may lead to invasive squamous cell carcinoma. Standard therapy includes local excision, partial or total penectomy, cryotherapy, and topical cytotoxic agents. Treatment of EOQ has proven to be challenging due to low response rates and recurrence. In addition, radical procedures can significantly affect sexual function and quality of life. Alternative laser treatments and photodynamic therapy (PDT) offer promising results for treating EOQ. A systemic review of the literature was performed for articles discussing laser and light therapy for EOQ. Among the patients treated with the CO2 laser, 81.4% of cases had complete remission after one session of treatment. Patients treated with PDT presented with more variable results, where 62.5% of those treated with methyl aminolevulinate photodynamic therapy (MAL-PDT) achieved complete remission. Aminolevulinic acid (ALA-PDT) treatment showed a similar rate of remission at 58.3%. One study utilized the Nd:YAG laser, which resulted in a recurrence of the lesion in four of the five patients treated. Of the methods reviewed, the CO2 laser offered the most promising results with a cosmetically excellent prognosis. Further studies with larger power and longer follow-up times are needed to determine the optimal treatment regimen for this penile malignancy.

Study on Incidence, Types and Treatment Options of Carcinoma Penis

Carcinoma penis is a common malignancy. Accounting for upto 10% of all cancers in uncircumcised male population in Asian countries. Carcinoma penis is almost unheard of races like the jews, who practice neonatal Circumcision. A very low incidence occurs in Muslims who undergo circumcision at around school going age. Squamous cell carcinoma accounts for at least 90% of all penile malignancies. 5% is constituted by adeno carcinoma Rest 5% by melanoma, Basal cell carcinoma & Sarcoma. It usually presents in sixth decade of life. It could be prevented or diagnosed early in most cases. The aim of the Study is to analyze the incidence, types, presenting symptoms and treatment of carcinoma penis. During 2009 and 2010 for a period of two years, 33 cases were admitted for treatment of carcinoma all the 33 cases were studied in detail with detailed clinical examination and special investigations like skin tests, serology, culture and special stains were done only wherever required. Histopathological examination of the primary lesion was done. The maximum incidence age group is found to e 41 - 50 years. About 21 cases reported as a papillary variety and the rest 12 cases reported as a flat variety which means 64% of cases reported as a papillary one and the rest 16% as flat one. Patients of the 58% patients with flat variety had regional lymph node metastasis whereas 68% out of the papillary pattern had regional lymph node metastasis. The bulk of patients in this study presented primarily for a growth in penis in 85% of cases. The treatment for the primary cancer, depending on the extent of lesion in the penis, one of the following three surgeries was done. Partial amputation was done in 11 patients and total amputation with perinea urethrostomy with emasculation in 12 cases and without emasculation inurethrostomy with emasculation in 12 cases. Age incidence of Carcinoma penis is high in fifth decade. The commonest site of distribution in carcinoma penis is Glans. Ulcer proliferative lesion was the commonest presentation in carcinoma penis. The majority of cases were of squamous cell carcinoma. The prognosis depends upon the stage and nodal status at presentation. Partial Amputation was done for stage I; Total Amputation for stage II; surgery alone or surgery and radiotherapy for stage III. Radiotherapy and Chemotherapy in combination with surgery or alone for stage IV disease.

Malignant Tumors of the Penis

Although penile cancer is rare in developed countries, it occurs more frequently in other parts of the world and causes significant morbidity and mortality. To review the current literature on the pathogenesis, risk factors, clinical presentation, staging, and treatment of premalignant and malignant tumors of the penis. A literature review using PubMed was conducted searching for articles on penile malignancies. The majority of penile cancers are in situ or invasive squamous cell carcinomas, although other rare tumors of the penis occur, such as melanoma, basal cell carcinoma, extramammary Paget's disease, and soft tissue sarcomas. Physicians should be aware of the risk factors and clinical presentation of penile malignancies because early diagnosis is essential in effective management and cure. Accurate staging is imperative for risk stratification and treatment planning. Depending on the type of tumor, size of tumor, location, staging, and grading, treatment modalities vary and may include topical chemotherapy, surgical excision, Mohs micrographic surgery, laser excision or ablation, systemic chemotherapy, and radiotherapy.

753 PENILE INTRAEPITHELIAL NEOPLASIA; INCIDENCE IN THE NETHERLANDS

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease II1 Apr 2012753 PENILE INTRAEPITHELIAL NEOPLASIA; INCIDENCE IN THE NETHERLANDS Robert Hoekstra, Evelien Trip, Fiebo Ten Kate, Simon Horenblas, and Tycho Lock Robert HoekstraRobert Hoekstra Utrecht, Netherlands More articles by this author , Evelien TripEvelien Trip Utrecht, Netherlands More articles by this author , Fiebo Ten KateFiebo Ten Kate Utrecht, Netherlands More articles by this author , Simon HorenblasSimon Horenblas Amsterdam, Netherlands More articles by this author , and Tycho LockTycho Lock Utrecht, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.839AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile intraepithelial neoplasia (PIN) is rarely diagnosed and considered as a premalignant condition, preceding an invasive penile cancer. Currently, the incidence of penile cancer tends to increase in the Netherlands; unclear is if this also applies for PIN. METHODS Data from patients diagnosed with a premalignant penile lesion in the Netherlands between January 1998 and December 2007 were collected from the unique nationwide histopathology registry (PALGA), this database is covering all pathology results of inhabitants in the Netherlands. The results from biopsies, circumcisions and partial or total penectomy specimens with premalignant penile lesions were evaluated. The premalignant lesions included were erythroplasia of Queyrat, Bowen's disease, bowenoid papulosis, mild, moderate and severe dysplasia and carcinoma in situ of the penis. The terminology used in the pathological reports was translated to PIN. The grading was made in analogy with the grading of vulvar premalignant lesions. Patients with a previous malignancy were excluded. When a penile malignancy was found within three months after a premalignant penile lesion was diagnosed, it was considered as primary penile carcinoma and these patients were excluded. In the pathology reports HPV status, location on the penis and the time-interval to malignant transformation were retrieved. RESULTS The PALGA database enrolled 658 patients with possible premalignant penile lesions between 1998-2007. After screening of these reports, 278 cases were eliminated because of exclusion criteria. Severe premalignant lesions (graded as PIN III) were found in 254 patients (67%), moderate PIN (PIN II) in 84 patients (22%), and mild PIN (PIN I) in 42 patients (11%). Most lesions were located on the prepuce (45%), followed by glans (38%) and shaft (3%). Median age of patients with PIN was 57 years; 51 years for PIN I and 60 years for PIN III. HPV-status was known in only 28 patients, in 11 (39%) HPV tests were negative and in 17 (61%) was tested positive. In 26 patients progression to malignant disease occurred (2% for PIN I versus 7% for PIN III). CONCLUSIONS PIN is a condition that is only rarely diagnosed, with an incidence in the Netherlands of 0.4-0.6 per 100,000 men. After a median follow up of 52 months (IQR 23-85) progression to malignancy was found in 7% of patients with PIN III. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e308 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Hoekstra Utrecht, Netherlands More articles by this author Evelien Trip Utrecht, Netherlands More articles by this author Fiebo Ten Kate Utrecht, Netherlands More articles by this author Simon Horenblas Amsterdam, Netherlands More articles by this author Tycho Lock Utrecht, Netherlands More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Yolk sac tumour of the penile shaft: A rare primary extra-gonadal presentation

Germ cell tumours (GCTs) commonly involve the ovaries, testes, and other midline structures in children and adolescents and comprised a variety of tumours that have a common histiogenetic origin. The yolk sac tumour (YST) variant is the most common one seen in over 80% of testicular GCTs in children. Other sites of occurrence of these tumours include the mediastinum, prostate, retroperitoneum, and sacrococcygeal region. Penile malignancies account for less than 10% of male malignancies in the elderly, while its occurrence in children is rare. We present the case of a 5-year-old child with YST of the penile shaft and uninvolved testes.

Long standing balanitis xerotica obliterans resulting in renal impairment in a child

Balanitis xerotica obliterans (BXO) is the most common cause of pathological phimosis in boys. Presented here is the case of a previously well 13-year-old boy who developed obstructive renal impairment (serum creatinine = 190 micromol/l) at least in part from phimosis due to BXO. A circumcision and, 2.5 months later, meatal dilatation were done. Nine months after his initial presentation, his serum creatinine returned to a permanently elevated nadir of 119 mumol/l. Presentation with the complications of phimosis can be delayed in teenage boys because they may feel embarrassed to come forward. Circumcision remains the definitive treatment of BXO induced phimosis though if the penile meatus is involved, more complex surgery is sometimes required. Topical steroids are useful for residual disease. Follow-up is very important due to the frequent involvement of the skin of the glans. In the very long term there is an increased chance of penile malignancy, which can occur even after circumcision.

Demographic and Pathologic Differences in the Incidence of Invasive Penile Cancer in the United States, 1995-2003

Penile cancer is an uncommon malignancy, so few descriptive or analytic studies have been reported in the literature. The objective of this analysis was to describe the distribution of penile cancer in the United States by demographic, pathologic, and clinical features. Penile cancer among 6,539 men was identified through 29 population-based registries in the United States during the period 1995-2003. These registries were estimated to represent 68% of the U.S. population. Age-adjusted incidence rates were calculated per million population using counts derived from the 2000 U.S. census. A subset of nine registries was used to examine time trends in penile cancer between 1973 and 2003. Squamous cell carcinomas were the most common histologic type of penile cancer, representing 93% of all malignancies. Hispanic men had the highest age-adjusted incidence rates per million for penile cancer (6.58 per million), followed by Blacks (4.02 per million), Whites (3.90 per million), American Indians (2.81 per million), and Asian-Pacific Islanders (2.40 per million). The highest rates of penile cancer were found among Hispanic men (46.9 per million) and Black men (36.2 per million) of ages >/=85 years. Penile malignancy was rare among males under age 20 years. Time trend analysis supported a significant decrease in the incidence of penile cancer for Blacks (annual percent change, -1.9%) and Whites (annual percent change, -1.2%). The majority (61%) of penile cancers were diagnosed at a localized stage among all racial and ethnic groups, although Hispanic and Black men tended to be diagnosed at more advanced stages than Whites. No racial or ethnic differences in tumor grade were identified. The incidence of penile cancer was highest in the South (4.42 per million) and lowest in the West (3.28 per million) of the United States. The highest age-adjusted incidence rate was found among Black men in the South (4.77 per million) and the lowest rate among Asian-Pacific Islanders in the West (1.84 per million). This analysis showed significant racial/ethnic and regional variation in the incidence of penile cancer. The high rate of penile cancer among Hispanic and Southern Black men suggests differences in risk factors for this malignancy, such as circumcision, hygiene, or human papillomavirus exposure.

Imaging of Penile Neoplasm

Penile malignancies are rare, accounting for less than 1% of all male malignancy in the United States. The diagnosis can be very devastating psychologically to patients and often presents a challenge for physicians to accurately diagnose and treat these neoplasms. Clinical examination is known to have certain limitations and cross-sectional imaging techniques are increasingly utilized. Knowledge in imaging characteristics of the normal anatomy of the penis, vascular supply, lymphatic drainage, and pathology of penile malignancy is essential for an accurate staging. In this article, normal anatomy of the penis is briefly discussed and is followed by a review of multiple imaging approaches for characterization of the primary tumor and nodal staging.

Reconstructive Surgery for Invasive Squamous Carcinoma of the Glans Penis

ObjectivesWe present medium-term outcome data for patients with invasive penile cancer treated with glansectomy and reconstruction with a split-thickness skin graft. MethodsA series of consecutive patients referred with penile malignancies over a 6-yr period were analyzed prospectively. A dedicated histopathologist reviewed all the specimens. After clinical staging, patients with tumours confined to the glans were offered glansectomy. ResultsA total of 72 patients (32% of patients, 31% of procedures) underwent glansectomy for penile carcinoma. Of these, 65 patients were new diagnoses and seven were recurrences after radiotherapy. The mean follow-up period was 27 mo (range: 4–68 mo). There have been three late local recurrences (4%). ConclusionGlansectomy appears to be an oncologically safe and effective procedure for patients with glans-confined squamous cell tumours. It preserves maximum phallic length and results in a very satisfactory cosmetic penile appearance after reconstruction.